342700449-8-21-2023-27-AS-SRIN-CV649N-20230828185436

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 342700449
Report Date: 08/21/2023
Date Signed: 08/21/2023 01:43:20 PM

Unfounded

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833

This is an official report of an unannounced visit/investigation of a complaint received in our office on
06/26/2023 and conducted by Evaluator Victoria Brown

COMPLAINT CONTROL NUMBER: 27-AS-20230626092157

FACILITY NAME:	GREENHAVEN BLISSFUL HOME		FACILITY NUMBER:	342700449
ADMINISTRATOR:	TORRES, CHRISTINE		FACILITY TYPE:	740
ADDRESS:	6200 FENNWOOD CT		TELEPHONE:	(916) 753-7564
CITY:	SACRAMENTO	STATE: CA	ZIP CODE:	95831
CAPACITY:	6	CENSUS: 6	DATE:	08/21/2023
		UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Christine Torres		TIME COMPLETED:	02:00 PM

ALLEGATION(S):

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Staff do not allow resident to visit with family
Staff did not safeguard resident's personal belonging
Staff do not allow resident to exit the facility

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Victoria Brown arrived unannounced on 8/21/23 at 9:00a to conclude the investigation of the above mentioned allegations. LPA met with Christine Torres and stated the purpose of the visit.

LPA conducted interviews of staff during this visit.

Regarding allegation, "Staff do not allow resident to visit with family" LPA obtained information through interviews that resident #1 (R1) was allowed visitors on a daily basis and no one was ever denied visitation rights. LPA obtained a copy of the visitors log dated 8/11/21 - 4/5/23 which indicates famiy did not sign-in when visiting R1. However, LPA observed that R1 received visits from other persons during this time frame.

Unfounded

Estimated Days of Completion: 60

SUPERVISOR'S NAME: Stephen Richardson	TELEPHONE: (916) 263-4746
LICENSING EVALUATOR NAME: Victoria Brown	TELEPHONE: (209) 814-1955
LICENSING EVALUATOR SIGNATURE:	DATE: 08/21/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/21/2023

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 27-AS-20230626092157

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833

FACILITY NAME: GREENHAVEN BLISSFUL HOME	FACILITY NUMBER: 342700449
	VISIT DATE: 08/21/2023

NARRATIVE

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Regarding allegation, "Staff did not safeguard resident's personal belonging" LPA obtained information through interviews that R1 would not allow staff in the room to assist with locating the missing cell phones. Per R2, R1 would only use the facility phone when making calls. LPA observed while cleaning R1's room, S5 located 3 cell phones.

Regarding allegation, "Staff do not allow resident to exit the facility" LPA did not observe through interviews an instance where resident was not allowed to leave the facility.

Based on interviews and observation, the allegations are deemed UNFOUNDED.

The allegations are UNFOUNDED, meaning that the allegation was false, could not have happened and/or was without a reasonable basis. This Department has therefore dismissed the complaint.

Per California Code of Regulations, no deficiencies were observed or cited.

Exit interview held, and a copy provided.

SUPERVISOR'S NAME: Stephen Richardson	TELEPHONE: (916) 263-4746
LICENSING EVALUATOR NAME: Victoria Brown	TELEPHONE: (209) 814-1955
LICENSING EVALUATOR SIGNATURE:	DATE: 08/21/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/21/2023

LIC9099 (FAS) - (06/04)

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